You are working evenings on an orthopedic floor.
One of your patients, J.O., is a 25-year-old who was a new admission on day shift. He was involved in a motor vehicle accident (MVA) during a high-speed police chase. His admitting diagnosis is status post (S/P) open reduction and internal fixation (ORIF) of the right femur (which was performed under general anesthesia), multiple rib fractures, sternal bruises, and multiple abrasions.
Your initial assessment reveals stable VS of 116/78, 84, 16, 98.6° F. He has crackles in lung bases bilaterally. He has a NGT (nasogastric tube) connected to LWS (low wall suction). He has an IV of D5LR infusing in his left arm at 125 ml/hr. His abdomen is soft and non-tender.
At 1900, J.O. summons you to the room and he is cold and clammy, groaning, pale, agitated, and slightly confused. VS are 90/palp, 140, 28, 98.0° F. His pulse is weak and thready. His abdomen is painful and appears to be increased in size. J. O. begins to vomit copious amounts of greenish/yellow fluid. You summon the physician and he orders a stat H & H with a type and cross match for 6 units of packed cells.
1. What else can you do for J. O. before the physician arrives?
Start another IV line because you can't infuse blood in the same IV with the D5LR, Give him oxygen, Keep monitoring vitals, Put the Head of the bed up so he doesn't aspirate his vomit,
I'm assuming he has an active GI Bleed, is there anything else I'm missing to help this patient??